Claims Assessor

Role Purpose : Full responsibility for 3rd party claims, including end-to-end assessment, decision making, reporting, analysis, and feedback to Life Operations and Capitec Operations Executives.

Additionally, responsible for other claims with similar end-to-end processes.

Requirements

Matric / Grade 12

Relevant Insurance Experience

Claims-related experience advantageous

Medical background advantageous

Underwriting background advantageous

At least 3-5 years claims handling experience

Duties & Responsibilities

Manage 3rd party claims (Non-mandated intermediaries)

Coordinate and perform full assessment to ensure swift claims processing

Support the life claims business unit

Respond to all emails within 24 hours

Capture claims onto the Claims System

Provide feedback to the life claims team and relevant binder holders

Prepare monthly reports

Escalate complex claims to the Claims Committee

Handle complaints professionally

Maintain knowledge of claims business practices and procedures

Understand cell captive information for correct client claim capture

Follow up with relevant parties for administration and query resolution

Understand technical medical terminology

Access and integrate information quickly

Apply Rule 17 of the PPRs and promote TCF outcomes

Interpret policy wording accurately

Apply Rule 18 of the PPRs

Deliver professional and efficient service

Promote TCF / PPR outcomes

Stay updated on Guardrisk developments

Handle extraordinary cases appropriately

Coordinate resolution processes and liaise with other business units as needed

Gather information to finalize claim capturing

Assess all third-party claims and claims landing in the inbox

Analyze data for trend identification and feedback

Assist with ad-hoc projects and record-keeping

Respond to complaints and perform root cause analysis

Competencies

Accountability for service delivery

Time management

Self-motivation

Collaboration

Living the company values

Discipline

Teamwork

Proficiency in Word, Excel, Outlook

Problem-solving skills

Organizational skills

Excellent verbal and written communication skills

Complaints management

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